TRICARE Senior Coordinating Nurse

Essential Job Duties and Responsibilities:

Overall Purpose Of The Job (Brief description of the primary purpose of this position)

This role will require close interface and regular communication with TRICARE our client, and with their beneficiaries who are enrolled throughout the Latin America-Canada region. 

The TRICARE Senior Coordinating Nurse will work closely with the Tricare Overseas Program (TOP) Medical and Operations team to drive a quality assured service to our beneficiaries. 

The TRICARE Senior Coordinating Nurse will be responsible for:

1. • Medical case management: including tasks for the Co-ordinating Nurse. 
   • Acting as an escalation point, the Senior Coordinating Nurse discusses cases with the medical team, providing clinical direction and ensuring standards of care are upheld for beneficiaries.
   • Working autonomously to deal with complex cases.
   • Interact with operations and logistical team coordinators to ensure optimal quality case management and service delivery. 
   • Performance of various management and administrative functions in support of the Nurse Manager

Key Responsibilities (Critical responsibilities and skills of this position, listed in order of importance)

 Medical Case Management:

• Provide telephonic medical assessment of beneficiaries in our region, refer to appropriate care and monitor the appropriateness of the treatment being received. 
• Speak with treating medical professionals and obtain medical updates for beneficiaries.
• Be responsible for the effective and efficient medical management of cases, meeting TOP contractual deliverables and internal policies and procedures. 

Leading the way:

• Be a source of guidance and support for junior colleagues, this includes:
  • Escalation point for medical team
  • Proactively assisting medical team in case management and “On the spot” training as necessary.
• Deputise for the Nurse Manager as required.
• Demonstrate effective coordination and time management by completing weekly allocations, ensuring appropriate staffing levels across the platform, and balancing operational needs with individual skill sets and availability.
• Assist the Medical Director in leading handover as a point of reference for policy and client demands.
• Promote and reinforce the need for evidence-based medical decision making and advice with clear documentation of the information and source.  
• Liaise with medical and operational staff to facilitate the efficient management and direction of case work.  Drive forward cases with an aim to providing customer service with the greatest efficiency.
• Undertake responsibility for all medical information released ensure consent and confidentiality are maintained as per HIPPA requirements.
• Monitor dashboard within CRM to track case volumes throughout the day, reallocating staff as needed to maintain operational efficiency.  Ensure performance remains with KPI. 
• Identify new and improved ways of case management by identifying and focusing on current platform areas and taking a proactive solution orientated approach.  
• Maintain accurate and confidential member case files in accordance with International SOS policies.
• Always ensure a high level of professionalism.
• To attend internal platform meetings with Ops, Senior Med Mgmt. and Quality team colleagues to promote networking and sharing of good practice.  Maintain progress tracker for LAC specific meetings to reflect platform progress.
• Effective communication with medical and operational colleagues (includes managing conflict and having challenging conversations).
• To mentor new staff, updating medical management and training team of their progress.
• To be accountable for workload and movements to line manager.
• To keep accurate records including statistical information where appropriate.
• To be a professional and approachable role model to all staff.
• To carry out any other reasonable duties and project work as requested by the manager.
• To assist with identifying ways of improving the working environment and sharing these ideas with management to aid staff retention.
• Assist with the recruitment process for LAC Nurses, including participation in interviews and running assessment centres.

Client focus: 

• Professionally communicate verbally and/or in writing to the TRICARE area office the progress of the beneficiaries’ condition and appropriate recommendations.
• Act as a deputy to the Nurse Man